成人髋关节发育不良不同Crowe分型的三维CT影像学特征

 目的 通过三维CT重建分析成人髋关节发育不良不同Crowe分型之间髋臼形态的演变规律。方法 2010年6月至2013年1月收治成人髋关节发育不良患者62例68髋,男6例8髋,女56例60髋;年龄47~59岁,平均（53.7±5.8）岁。CroweⅠ型14例17髋,Ⅱ型17例17髋,Ⅲ型15例17髋,Ⅳ型16例17髋。行标准髋关节CT扫描及三维重建。在侧位三维图像上标记Harris窝,确定髋臼旋转中心,利用十字坐标轴确定髋臼旋转中心的冠状面和横断面位置;在正位三维图像上利用Ranwant三角确定髋臼旋转中心的矢状面位置;在髋臼水平重建图像上确定髋臼旋转中心。观察髋臼前后缘增生及髋臼前后柱发育不良程度,测量并比较不同Crowe分型患者的髋臼前倾角、前覆盖角、后覆盖角和内壁宽度。结果 随Crowe分型增加,髋臼前倾角逐渐加大,两者呈正相关,除CroweⅠ型和Ⅱ型组间外,其余组间差异有统计学意义;髋臼前覆盖角逐渐减小,两者呈负相关,各组间差异均有统计学意义,CroweⅢ、Ⅳ型组平均值小于50°;髋臼后覆盖角逐渐减小,两者呈负相关,各组间差异均有统计学意义, CroweⅢ、Ⅳ型组平均值小于90° ;髋臼内壁宽度逐渐增加,两者呈正相关,各组间差异均有统计学意义。结论 不同Crowe分型成人髋关节发育不良的髋臼形态变化存在一定的演变规律。对CroweⅠ型和Ⅱ型髋臼的重建可充分利用髋臼前后柱骨量,对CroweⅢ、Ⅳ型髋臼的重建可适度上移和（或）内移髋臼中心。     

Positron emission tomography–computed tomography in the assessment of viability of femoral head in acetabular fractures

Purpose

The aim of this study was to use positron emission tomography–computed tomography (PET-CT) imaging as a tool for assessment of viability of femoral head in acetabular fractures and help in early detection of complications like avascular necrosis (AVN) of the femoral head.

Methods

In our study PET-CT was done pre-operatively and six weeks postoperatively in 31 patients who underwent open reduction and internal fixation (ORIF) of acetabular fractures and fracture–dislocations. There were 26 male and five female patients who were treated in our institute between January 2009 and July 2010. Patients were subsequently followed up with plain radiographs for a mean period of 3.8 years and minimum of two years.

Results

Although seven out of 31 patients showed avascularity of the femoral head on PET-CT in the pre-operative period, only two patients progressed to AVN at final follow up, whereas the other five patients regained the vascularity at the end of six weeks. There was no statistically significant correlation between vascular status on pre-operative scan and the presence of AVN on final follow-up radiograph. There was a significant correlation between avascularity of the femoral head on the sixth week PET-CT and AVN in the final radiograph.

Conclusion

PET-CT seems to be useful as a prognostic investigation in the assessment of the vascular status of the femoral head following injuries around the hip. Both pre-operative and postoperative imaging are necessary to understand the time-dependent changes in blood flow following injury.     

Correlation between groin pain and cup design of hip-resurfacing implants: a prospective study

Purpose

Cup design has been incriminated as the source of groin pain after hip resurfacing but has not been well described; thus, it was assessed in a prospective study looking at three implant types.

Methods

A group-match was done between three groups of hip resurfacing devices according to age, sex, body mass index, activity level, osteoarthritis aetiology and pre-operative scores.

Results

The global groin pain rate was 5.7 % at six months and 2.7 % at last follow-up. Groin pain rate was significantly different between the three groups (p = 0.004) and had a strong influence on the subjective results (p = 0.04). No groin pain emerged between six months and last follow-up. No clinical differences were noted in Harris hip score and Merle d’Aubigné-Postel score at last follow-up. However, the Oxford hip score and Devane activity score were significantly lower for cups with macrostructures.

Conclusion

The low groin pain rate in this prospective cohort was probably secondary to the specific surgical technique used and seems to be correlated with cup design. Macrostructures on the external part of the cup could be significantly harmful.     

界膜与人工髋关节松动的相关性分析

目的：通过对松动假体界膜的研究分析人工髋关节松动的原因。方法：通过对28例人工髋关节翻修术中松动假体周围界膜组织进行肉眼外观及扫描电镜对表面超微结构的观察来分析人工髋关节无菌性松动与界膜之间的相关联系。结果：所有本组28例松动假体周围均充填有薄厚大小不一的界膜组织,多数颜色为暗红色,约1／3的界膜部分有黑色;界膜较厚处质韧类似瘢痕结缔组织,薄处似纤维薄膜。扫描电镜观察可以见到大量的粗细不等排列无序的胶原纤维组织和大小不一分布不均的异物颗粒和骨碎屑,胶原纤维内有成纤维细胞分布。结论：人工假体与骨骼形状不完全匹配,空隙的产生导致纤维瘢痕组织（界膜）充填,磨损微粒沿空隙扩散至界膜刺激界膜释放炎性细胞因子导致骨溶解而出现假体松动,松动后的假体与骨髓腔空隙加大导致更多界膜组织充填、释放溶骨性细胞因子而形成恶性循环。     

髋关节置换术老龄患者实施临床护理路径的干预效果分析

目的：探讨髋关节置换术老龄患者实施临床护理路径的干预效果。方法常规组患者实施髋关节置换术常规护理流程,研究组患者实施髋关节置换术临床护理路径模式来进行护理。对两组的住院时长及总宣教时长进比照。对两组术后48h 的腰背、创口疼痛情况及术后6个月的髋关节功能进行比照。疼痛评分应用现时疼痛强度（PPI）6级评分法,即0～5级对应无痛至剧烈疼痛;髋关节功能实施 Harris 评分标准。最后统计术后并发症发生情况。结果研究组其住院时长及总宣教时长显著少于常规组（P ＜0.05）,其腰背痛及创口痛显著轻于常规组（P ＜0.05）,其髋关节功能恢复程度显著优于常规组（P ＜0.05）。研究组其术后便秘、尿潴留、压疮、肺部感染及创口感染发生率均显著低于常规组（P ＜0.05）。结论髋关节置换术老龄患者实施临床护理路径可显著提升治疗效果,缩短住院时长、遏制并发症的发生,且患者术后髋关节功能更好。     

DXA 髋结构分析参数预测髋部脆性骨折的价值

目的探讨双能X线吸收测量法(DXA)髋几何力学参数在预测髋部脆性骨折风险中的应用价值。方法髋部骨折女性患者41例(年龄52.3~89.4岁)及正常对照组259例(年龄28.2~88.3岁)行DXA扫描获取股骨颈骨密度(femur neck BMD,FN_BMD)及髋几何力学分析参数,包括股骨颈横截面惯性矩(CSMI)、股骨颈横截面面积(CSA)、截面模数(SM)、曲率比率(BR)、颈宽度(FNW)、髋轴长(HAL)、股骨颈干角(NSA),并计算股骨近端强度指数(FSI)。利用受试者工作特征曲线(ROC)分析相关变量判定髋部骨折的效能。结果校正年龄、身高、体重、BMI混杂因素,髋部骨折组与非骨折组间FN_BMD差异有显著性意义(P0.01),髋部骨折组FSI、SM、CSMI、CSA较非骨折组低(P均0.05),而BR、FNW、NSA、HAL较非骨折组高(P均0.05);当校正FN_BMD时,只有FSI、NSA及HAL在两组间差异仍有统计学意义(P均0.05)。控制混杂因素,FN_BMD与FSI(r=0.339)、BR(r=-0.291)、SM(r=0.644)、CSMI(r=0.425)、NSA(r=-0.291)呈轻-中度相关性,FN_BMD与CSA相关密切性最好(r=0.908,P0.001)。FN_BMD、FSI、HAL、NSA判定髋部骨折的ROC曲线下面积(AUC)分别为0.794±0.031、0.790±0.032、0.652±0.049、0.684±0.049。FN_BMD及FSI判定髋部骨折的效能相仿(P=0.9128)。FN_BMD联合FSI判定髋部骨折的AUC为0.844±0.039,较FN_BMD大(P0.05)。结论 FSI独立于FN_BMD起作用,可作为判断骨质疏松性髋部骨折的有用因子。FN_BMD联合FSI可以提高预测髋部骨折风险的能力。     

体脂量是绝经后女性股骨近端骨强度的决定因素

正Lower body weight or body mass index(BMI)has been known to be higher risk of developing osteoporosis and low-energy fractures via mechanical loading and other factors in both men and women[1].Recently,there have been new insights into the relationships between body composition and bone health.However,most of the previous studies regarding the relative effect of body composition on bone mass yielded inconsistent     

Segmental neck of femur fractures: A unique case report of an ipsilateral subcapital,greater trochanteric and intertrochanteric fracture and proposed management algorithm

INTRODUCTION

Neck of femur fractures are now increasingly common in an ageing population. The management is well known and has been described in great detail. Concomitant ipsilateral segmental fractures of the neck of femur (SFNOF) however are rare and their investigation and management is poorly described.

PRESENTATION OF CASE

We present the surgical management of a unique and complex case of an ipsilateral subcapital, greater trochanteric and intertrochanteric fracture sustained in an 87-year-old female following a low trauma injury. This fracture configuration has not been described in the literature to date, neither has our method of reconstruction for this fracture, namely hemiarthorplasty, trochanteric stabilising plate and cerclage wires.

DISCUSSION

15 cases from 1989 to 2011 managed by 8 different fixation devices and followed up for an average of 17 months (2–58 months). There was an initial mortality rate of 13% (n = 2). All associated with low energy trauma occurred in female (n = 8), and most with high energy trauma occurred in males (83%; n = 5). The diagnosis was delayed or missed in 20% of cases, and the most common pattern was a concomitant undisplaced subcapital and intertrochanteric fracture (37.5%, n = 6). The overall risk of avascular necrosis was 20%, with a greater risk in patients greater than 65 years of age (33%).

CONCLUSION

Ipsilateral SFNOF are rare injuries with a bimodal distribution, and carry a greater risk of AVN. We advise that all SFNOF should have pre-operative CT planning and propose an algorithm to treat these patients with a standardised surgical approach.     

幼儿正常髋关节的超声研究

本文对30例1～3岁幼儿进行了正常髋关节的超声检查。利用三种扫查切面，分析了正常髋关节各结构的声像图特点。利用超声，可以无创地、反复地对幼儿髋关节的结构进行观察，在幼儿髋关节疾病的治疗、预后及随访中具有临床应用价值*